Emergency Response and Unknown Substance
Comprehensive Substance Reference & Harm Reduction Guide
Emergency Response and Unknown Substance
Clean Rebuilt Edition - September 2026
IMPORTANT: This guide is for recognition, harm-reduction, and emergency-reference purposes. Appearance alone cannot reliably identify a substance. Counterfeit pills, powders, vapes, edibles, and street mixtures may contain unexpected drugs. Do not taste, smell closely, burn, or handle an unknown substance to identify it. If poisoning is possible, contact Poison Control (U.S. 1-800-222-1222) or 911 for severe symptoms.
Emergency Response - Start Here
1. Check responsiveness and breathing: If the person is unresponsive, has abnormal or slow or absent breathing, turns blue or gray, has a seizure, severe chest pain, dangerous overheating, or cannot be kept safe, call 911.
2. Give naloxone when opioid exposure is possible: Use naloxone if available. If normal breathing does not return after about 2-3 minutes, give another dose according to product directions. Naloxone will not reverse non-opioid sedation, but it can treat an opioid component.
3. Support breathing: Open the airway. Give rescue breaths and/or CPR according to your training and dispatcher instructions. Use an AED if available and indicated.
4. Recovery position: If unconscious but breathing adequately, place the person on their side to reduce choking risk.
5. Seizure and overheating safety: Protect the head, clear nearby hazards, do not put anything in the mouth, and do not forcibly restrain. For dangerous overheating, move to a cooler environment and begin active cooling while EMS is responding.
6. Stay with the person: Monitor breathing and responsiveness until emergency personnel arrive. Keep containers, pill bottles, packages, or photos available for responders when safe to do so.
7. Avoid harmful actions: Do not assume someone can "sleep it off" if they are difficult to wake, breathing abnormally, or turning blue or gray. Do not put an unconscious person in a cold shower or bath, force food or liquids into an unconscious or seizing person, induce vomiting unless instructed by Poison Control, or put objects or fingers in the mouth of someone having a seizure.
Unknown Substance or Unknown Pill
Never identify an unknown drug solely by color, logo, shape, odor, packaging, or street name. Counterfeit tablets can closely resemble legitimate medication.
If a prescription pill looks different than expected, check the imprint and contact the dispensing pharmacy or Poison Control rather than relying on appearance alone.
If the substance is unknown and symptoms are developing, focus on the person's condition - breathing, consciousness, seizures, chest pain, temperature, and behavior - rather than trying to determine the exact drug first.
For non-emergency poison exposures in the United States, Poison Control is available at 1-800-222-1222. Severe symptoms require 911.